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Automated Segmentation of Lesions Including Subretinal Hyperreflective Material in Neovascular Age-related Macular Degeneration. Am J Ophthalmol 2018; 191:64-75. [PMID: 29655643 DOI: 10.1016/j.ajo.2018.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate an automated segmentation algorithm with a convolutional neural network (CNN) to quantify and detect intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and subretinal hyperreflective material (SHRM) through analyses of spectral-domain optical coherence tomography (SD-OCT) images from patients with neovascular age-related macular degeneration (nAMD). DESIGN Reliability and validity analysis of a diagnostic tool. METHODS We constructed a dataset including 930 B-scans from 93 eyes of 93 patients with nAMD. A CNN-based deep neural network was trained using 11 550 augmented images derived from 550 B-scans. The performance of the trained network was evaluated using a validation set including 140 B-scans and a test set of 240 B-scans. The Dice coefficient, positive predictive value (PPV), sensitivity, relative area difference (RAD), and intraclass correlation coefficient (ICC) were used to evaluate segmentation and detection performance. RESULTS Good agreement was observed for both segmentation and detection of lesions between the trained network and clinicians. The Dice coefficients for segmentation of IRF, SRF, SHRM, and PED were 0.78, 0.82, 0.75, and 0.80, respectively; the PPVs were 0.79, 0.80, 0.75, and 0.80, respectively; and the sensitivities were 0.77, 0.84, 0.73, and 0.81, respectively. The RADs were -4.32%, -10.29%, 4.13%, and 0.34%, respectively, and the ICCs were 0.98, 0.98, 0.97, and 0.98, respectively. All lesions were detected with high PPVs (range 0.94-0.99) and sensitivities (range 0.97-0.99). CONCLUSIONS A CNN-based network provides clinicians with quantitative data regarding nAMD through automatic segmentation and detection of pathologic lesions, including IRF, SRF, PED, and SHRM.
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Cheng QE, Gao J, Kim BJ, Ying GS. Design Characteristics of Geographic Atrophy Treatment Trials: Systematic Review of Registered Trials in ClinicalTrials.gov. ACTA ACUST UNITED AC 2018; 2:518-525. [DOI: 10.1016/j.oret.2017.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/20/2017] [Accepted: 08/16/2017] [Indexed: 01/24/2023]
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53
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Chen CL, Chen YH, Liang CM, Tai MC, Lu DW, Chen JT. Glucosamine-Induced Autophagy through AMPK⁻mTOR Pathway Attenuates Lipofuscin-Like Autofluorescence in Human Retinal Pigment Epithelial Cells In Vitro. Int J Mol Sci 2018; 19:ijms19051416. [PMID: 29747425 PMCID: PMC5983587 DOI: 10.3390/ijms19051416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/20/2018] [Accepted: 05/08/2018] [Indexed: 12/02/2022] Open
Abstract
Age-related macular degeneration (AMD) is a vision-threatening age-associated disease. The retinal pigment epithelial (RPE) cells phagocytose and digest photoreceptor outer segment (POS). Incomplete digestion of POS leads to lipofuscin accumulation, which contributes to the pathology of the AMD. Autophagy could help reduce the amount of lipofuscin accumulation. In the present study, we evaluated the effects of glucosamine (GlcN), a natural supplement, on the induction of autophagy and POS-derived lipofuscin-like autofluorescence (LLAF) in ARPE-19 cells in vitro, and investigated the potential molecular pathway involved. Our results revealed that GlcN had no effect on phagocytosis of POS at the lower doses. GlcN treatment induced autophagy in cells. GlcN decreased the LLAF in native POS-treated cells, whereas malondialdehyde or 4-hydroxynonenal-modified POS attenuated this effect. 3-Methyladenine inhibited GlcN-induced autophagy and attenuated the effect of GlcN on the decrease of the native POS-derived LLAF. Furthermore, GlcN induced the phosphorylation of AMP-activated protein kinase (AMPK) and inhibited the phosphorylation of mammalian target of rapamycin (mTOR), whereas Compound C inhibited these effects of GlcN. Altogether, these results suggest that GlcN decreased the native POS-derived LLAF through induction of autophagy, at least in part, by the AMPK–mTOR pathway. This mechanism has potential for the preventive treatment of lipofuscin-related retinal degeneration such as AMD.
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Affiliation(s)
- Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
| | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114, Taiwan.
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54
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Piippo N, Korhonen E, Hytti M, Skottman H, Kinnunen K, Josifovska N, Petrovski G, Kaarniranta K, Kauppinen A. Hsp90 inhibition as a means to inhibit activation of the NLRP3 inflammasome. Sci Rep 2018; 8:6720. [PMID: 29712950 PMCID: PMC5928092 DOI: 10.1038/s41598-018-25123-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023] Open
Abstract
Once activated, the intracellular receptor NLRP3 assembles an inflammasome protein complex that facilitates the caspase-1-mediated maturation of IL-1β and IL-18. Inactive NLRP3 is guarded by a protein complex containing Hsp90. In response to stress stimuli, Hsp90 is released, and NLRP3 can be activated to promote inflammation. In this study, we blocked Hsp90 with geldanamycin and studied the fate of NLRP3 in human retinal pigment epithelial (RPE) cells. RPE cells play a central role in the development of age-related macular degeneration (AMD), a progressive eye disease causing severe vision loss in the elderly. IL-1α-primed ARPE-19 cells, human embryonal stem cell (hESC)-derived RPE cells, and primary human RPE cells were exposed to MG-132 and bafilomycin A to activate NLRP3 via the inhibition of proteasomes and autophagy, respectively. Additionally, RPE cells were treated with geldanamycin at different time points and the levels of NLRP3 and IL-1β were determined. Caspase-1 activity was measured using a commercial assay. Geldanamycin prevented the activation of the inflammasome in human RPE cells. NLRP3 released from its protective complex became degraded by autophagy or secreted from the cells. Controlled destruction of NLRP3 is a potential way to regulate the inflammation associated with chronic diseases, such as AMD.
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Affiliation(s)
- Niina Piippo
- School of Pharmacy, University of Eastern Finland, Kuopio, 70211, Finland
| | - Eveliina Korhonen
- School of Pharmacy, University of Eastern Finland, Kuopio, 70211, Finland
| | - Maria Hytti
- School of Pharmacy, University of Eastern Finland, Kuopio, 70211, Finland
| | - Heli Skottman
- Faculty of Medicine and Life Sciences, BioMediTech, University of Tampere, Tampere, 33014, Finland
| | - Kati Kinnunen
- Department of Ophthalmology, Kuopio University Hospital, Kuopio, 70211, Finland
| | - Natasha Josifovska
- Stem Cells and Eye Research Laboratory, Department of Ophthalmology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Goran Petrovski
- Stem Cells and Eye Research Laboratory, Department of Ophthalmology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.,Center for Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Kai Kaarniranta
- Department of Ophthalmology, Kuopio University Hospital, Kuopio, 70211, Finland.,Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, 70211, Finland
| | - Anu Kauppinen
- School of Pharmacy, University of Eastern Finland, Kuopio, 70211, Finland.
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Age-Related Macular Degeneration: New Paradigms for Treatment and Management of AMD. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:8374647. [PMID: 29484106 PMCID: PMC5816845 DOI: 10.1155/2018/8374647] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 12/06/2017] [Indexed: 12/03/2022]
Abstract
Age-related macular degeneration (AMD) is a well-characterized and extensively studied disease. It is currently considered the leading cause of visual disability among patients over 60 years. The hallmark of early AMD is the formation of drusen, pigmentary changes at the macula, and mild to moderate vision loss. There are two forms of AMD: the “dry” and the “wet” form that is less frequent but is responsible for 90% of acute blindness due to AMD. Risk factors have been associated with AMD progression, and they are taking relevance to understand how AMD develops: (1) advanced age and the exposition to environmental factors inducing high levels of oxidative stress damaging the macula and (2) this damage, which causes inflammation inducing a vicious cycle, altogether causing central vision loss. There is neither a cure nor treatment to prevent AMD. However, there are some treatments available for the wet form of AMD. This article will review some molecular and cellular mechanisms associated with the onset of AMD focusing on feasible treatments for each related factor in the development of this pathology such as vascular endothelial growth factor, oxidative stress, failure of the clearance of proteins and organelles, and glial cell dysfunction in AMD.
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Maniglia M, Soler V, Cottereau B, Trotter Y. Spontaneous and training-induced cortical plasticity in MD patients: Hints from lateral masking. Sci Rep 2018; 8:90. [PMID: 29311565 PMCID: PMC5758612 DOI: 10.1038/s41598-017-18261-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/04/2017] [Indexed: 12/04/2022] Open
Abstract
Macular degeneration (MD) affects central vision and represents the leading cause of visual diseases in elderly population worldwide. As a consequence of central vision loss, MD patients develop a preferred retinal locus (PRL), an eccentric fixation point that replaces the fovea. Here, our aim was to determine whether and to what extent spontaneous plasticity takes place in the cortical regions formerly responding to central vision and whether a visual training based on perceptual learning (PL) can boost this plasticity within the PRL area. Spontaneous and PL-induced cortical plasticity were characterized by using lateral masking, a contrast sensitivity modulation induced by collinear flankers. This configuration is known to be sensitive to neural plasticity and underlies several rehabilitation trainings. Results in a group of 4 MD patients showed that collinear facilitation was similar to what observed in age- and eccentricity-matched controls. However, MD patients exhibited significantly reduced collinear inhibition, a sign of neural plasticity, consistent with the hypothesis of partial cortical reorganization. Three AMD patients from the same group showed a further reduction of inhibition after training, but not controls. This result suggests that PL might further boost neural plasticity, opening promising perspectives for the development of rehabilitation protocols for MD patients.
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Affiliation(s)
- Marcello Maniglia
- UC Riverside, Riverside, California, USA. .,Université de Toulouse-UPS, Centre de Recherche Cerveau et Cognition, Toulouse, France. .,Centre National de la Recherche Scientifique, Toulouse, Cedex, France.
| | - Vincent Soler
- Unité de rétine, consultation d'ophtalmologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place Baylac, 31059, Toulouse, cedex, France
| | - Benoit Cottereau
- Université de Toulouse-UPS, Centre de Recherche Cerveau et Cognition, Toulouse, France.,Centre National de la Recherche Scientifique, Toulouse, Cedex, France
| | - Yves Trotter
- Université de Toulouse-UPS, Centre de Recherche Cerveau et Cognition, Toulouse, France.,Centre National de la Recherche Scientifique, Toulouse, Cedex, France
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57
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Song WS, Yoon WT, Kim YK, Park SP. Analysis of 25-Hydroxy Vitamin D in the Aqueous Humor of Age-related Macular Degeneration Patients. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.11.1024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won Seok Song
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | | | - Yong-Kyu Kim
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sung Pyo Park
- Department of Ophthalmology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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58
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The Antibiotic-free pFAR4 Vector Paired with the Sleeping Beauty Transposon System Mediates Efficient Transgene Delivery in Human Cells. MOLECULAR THERAPY. NUCLEIC ACIDS 2017; 11:57-67. [PMID: 29858090 PMCID: PMC5852330 DOI: 10.1016/j.omtn.2017.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022]
Abstract
The anti-angiogenic and neurogenic pigment epithelium-derived factor (PEDF) demonstrated a potency to control choroidal neovascularization in age-related macular degeneration (AMD) patients. The goal of the present study was the development of an efficient and safe technique to integrate, ex vivo, the PEDF gene into retinal pigment epithelial (RPE) cells for later transplantation to the subretinal space of AMD patients to allow continuous PEDF secretion in the vicinity of the affected macula. Because successful gene therapy approaches require efficient gene delivery and stable gene expression, we used the antibiotic-free pFAR4 mini-plasmid vector to deliver the hyperactive Sleeping Beauty transposon system, which mediates transgene integration into the genome of host cells. In an initial study, lipofection-mediated co-transfection of HeLa cells with the SB100X transposase gene and a reporter marker delivered by pFAR4 showed a 2-fold higher level of genetically modified cells than when using the pT2 vectors. Similarly, with the pFAR4 constructs, electroporation-mediated transfection of primary human RPE cells led to 2.4-fold higher secretion of recombinant PEDF protein, which was still maintained 8 months after transfection. Thus, our results show that the pFAR4 plasmid is a superior vector for the delivery and integration of transgenes into eukaryotic cells.
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59
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Graham BC, Pulido JS, Winters JL. Seeing is believing: A review of apheresis therapy in the treatment of ophthalmologic disease. J Clin Apher 2017; 33:380-392. [PMID: 29150864 DOI: 10.1002/jca.21607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 12/27/2022]
Abstract
Apheresis procedures have a role in treatment of disparate diseases involving many different organ systems. Often the disease processes where apheresis plays a role in treatment are considered "orphan diseases"-relatively rare disease processes that lack specific pharmaceutical agents or established treatment protocols. Many of these disease processes can affect the eye with devastating results for the eyesight of these patients. The unique ability of apheresis to affect disease by modifying blood plasma and modulating disease-causing agents therein renders apheresis procedures valuable tools in the treatment of certain ophthalmologic diseases. This review comprehensively evaluates the role of apheresis in the treatment of ophthalmologic diseases of the eye and surrounding orbit including age-related macular degeneration, bilateral diffuse uveal melanocytic proliferation, paraneoplastic retinopathy, atopic keratoconjunctivitis, sympathetic ophthalmia, and endocrine-associated ophthalmopathy. Apheresis procedure parameters are provided for the apheresis practitioner based on review of the relevant literature.
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Affiliation(s)
- Brendan C Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey L Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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60
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Obata R, Yanagi Y, Inoue T, Yasuda M, Oshima Y, Sawaguchi S, Iwase A, Araie M. Prevalence and factors associated with age-related macular degeneration in a southwestern island population of Japan: the Kumejima Study. Br J Ophthalmol 2017; 102:1047-1053. [PMID: 29146756 DOI: 10.1136/bjophthalmol-2016-309980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the prevalence of and factors associated with age-related macular degeneration (AMD) in a rural population of southwestern Japan. METHODS This population-based cross-sectional study of all residents aged 40 years or older was conducted on the island of Kumejima, Okinawa, Japan. Of 4632 eligible residents, 3762 completed a comprehensive questionnaire and underwent ocular examination (participant rate, 81.2%). A non-mydriatic fundus photograph was used to grade AMD lesions according to the Wisconsin protocol. Prevalence of AMD was calculated and factors associated with AMD were identified by logistic regression. RESULTS Of 3068 subjects with gradable photographs, 469 had early AMD and 4 had late AMD. Age-adjusted prevalence was 13.4% for any AMD, 13.3% for early AMD and 0.09% for late AMD. In multivariate analysis, any AMD was positively associated with age (OR 1.04 per year, 95% CI 1.03 to 1.05), male sex (OR 1.42, 95% CI 1.14 to 1.75) and history of cataract surgery (OR 1.35, 95% CI 1.00 to 1.82) and was negatively associated with longer axial length (OR 0.85 per millimetre, 95% CI 0.74 to 0.96). Early AMD similarly showed significant associations with these same factors. CONCLUSIONS Prevalence of early or late AMD in a southwestern island population of Japan was 13.4% or 0.09%. Our data suggest relatively high prevalence for early AMD and low prevalence for late AMD in this sample of rural Japanese population. Significant factors associated with any or early AMD were mostly similar to that of previous studies.
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Affiliation(s)
- Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuo Yanagi
- Department of Medical Retina, Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS (National University of Singapore) Graduate Medical School, Singapore, Singapore
| | - Tatsuya Inoue
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Miho Yasuda
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuji Oshima
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoichi Sawaguchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | - Makoto Araie
- Kanto Central Hospital of The Mutual Aid Association of Public School Teachers, Tokyo, Japan
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61
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Chatziralli IP, Sergentanis TN. Ocular gene therapy for neovascular AMD: a new era? Lancet 2017; 390:2139-2140. [PMID: 29143749 DOI: 10.1016/s0140-6736(17)32447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Irini P Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens 12462, Greece.
| | - Theodoros N Sergentanis
- Department of Epidemiology and Biostatistics, National and Kapodistrian University of Athens, Athens 12462, Greece
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62
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Exudative retinal detachment. Surv Ophthalmol 2017; 62:723-769. [DOI: 10.1016/j.survophthal.2017.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
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63
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Xiying M, Wenbo W, Wangyi F, Qinghuai L. Association of Apolipoprotein E Polymorphisms with Age-related Macular Degeneration Subtypes: An Updated Systematic Review and Meta-analysis. Arch Med Res 2017; 48:370-377. [PMID: 28889998 DOI: 10.1016/j.arcmed.2017.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Age-related macular degeneration (AMD) is the worldwide leading cause of blindness among the elderly, especially in developed countries. The possible association between apolipoprotein E (ApoE) polymorphism (ε2, ε3, ε4) and AMD has been extensively investigated with conflicting results, especially when specifying different clinical phenotypes of AMD. Herein, we conducted a meta-analysis by integrating several recent large-sample studies to verify the effect of ApoE polymorphisms on AMD subtypes. METHODS The retrieve for targeted literature was conducted based on the PubMed, Embase, Cochrane library, and Web of Science. Summary odds ratio (OR) and its 95% confidence intervals (CIs) were used for estimation of risk. The p-value was adjusted due to the multiple comparison. RESULTS A total of 12 studies included in the final summary analysis, including 13842 cases and 38647 controls. ApoE ε4 carrier was inversely associated with early stage AMD (OR = 0.889, 95% CI = 0.82-0.97), geographic atrophy (OR = 0.594, 95% CI = 0.43-0.83) and neovascular AMD (OR = 0.670, 95% CI = 0.58-0.76). Stratification analysis by ethnicity revealed that the ApoE ε4 carriers was associated with neovascular AMD in both Caucasians (OR = 0.62, 95% CI = 0.47-0.83) and East Asians (OR = 0.68, 95% CI = 0.58-0.79). A significant association of ApoE ε2 carriers was only found with early AMD in Black and East Asian population, however small samples and limited studies restrict its generalization. CONCLUSION Our meta-analysis revealed a significantly protective role of ε4 on each subtypes of AMD, but no supportive evidence of the association of ε2 with AMD. Thus, further studies with larger samples are needed to understand the precise role of ε2 on AMD susceptibility.
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Affiliation(s)
- Mao Xiying
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wu Wenbo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Wangyi
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Liu Qinghuai
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
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64
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Dwivedi S, Purohit P, Misra R, Pareek P, Goel A, Khattri S, Pant KK, Misra S, Sharma P. Diseases and Molecular Diagnostics: A Step Closer to Precision Medicine. Indian J Clin Biochem 2017; 32:374-398. [PMID: 29062170 PMCID: PMC5634985 DOI: 10.1007/s12291-017-0688-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current advent of molecular technologies together with a multidisciplinary interplay of several fields led to the development of genomics, which concentrates on the detection of pathogenic events at the genome level. The structural and functional genomics approaches have now pinpointed the technical challenge in the exploration of disease-related genes and the recognition of their structural alterations or elucidation of gene function. Various promising technologies and diagnostic applications of structural genomics are currently preparing a large database of disease-genes, genetic alterations etc., by mutation scanning and DNA chip technology. Further the functional genomics also exploring the expression genetics (hybridization-, PCR- and sequence-based technologies), two-hybrid technology, next generation sequencing with Bioinformatics and computational biology. Advances in microarray “chip” technology as microarrays have allowed the parallel analysis of gene expression patterns of thousands of genes simultaneously. Sequence information collected from the genomes of many individuals is leading to the rapid discovery of single nucleotide polymorphisms or SNPs. Further advances of genetic engineering have also revolutionized immunoassay biotechnology via engineering of antibody-encoding genes and the phage display technology. The Biotechnology plays an important role in the development of diagnostic assays in response to an outbreak or critical disease response need. However, there is also need to pinpoint various obstacles and issues related to the commercialization and widespread dispersal of genetic knowledge derived from the exploitation of the biotechnology industry and the development and marketing of diagnostic services. Implementation of genetic criteria for patient selection and individual assessment of the risks and benefits of treatment emerges as a major challenge to the pharmaceutical industry. Thus this field is revolutionizing current era and further it may open new vistas in the field of disease management.
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Affiliation(s)
- Shailendra Dwivedi
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Radhieka Misra
- Era's Lucknow Medical College and Hospital, Lucknow, 226003 India
| | - Puneet Pareek
- Department of Radio-Therapy, All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, 226003 India
| | - Sanjay Khattri
- Department of Pharmacology and Therapeutics, King George Medical University, Lucknow, 226003 India
| | - Kamlesh Kumar Pant
- Department of Pharmacology and Therapeutics, King George Medical University, Lucknow, 226003 India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, 342005 India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, 342005 India
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65
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Montgomery MP, Postel E, Umbach DM, Richards M, Watson M, Blair A, Chen H, Sandler DP, Schmidt S, Kamel F. Pesticide Use and Age-Related Macular Degeneration in the Agricultural Health Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:077013. [PMID: 28886597 PMCID: PMC5744702 DOI: 10.1289/ehp793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a leading cause of blindness in developed countries. Few studies have investigated its relationship to environmental neurotoxicants. In previous cross-sectional studies, we found an association between pesticide use and self-reported retinal degeneration. OBJECTIVE We evaluated the association of pesticide use with physician-confirmed incident AMD. METHODS The Agricultural Health Study (AHS) is a prospective cohort of pesticide applicators and their spouses enrolled from 1993-1997 in Iowa and North Carolina. Cohort members reported lifetime use of 50 specific pesticides at enrollment. Self-reports of incident AMD during follow-up through 2007 were confirmed by reports from participants' physicians and by independent evaluation of retinal photographs provided by the physicians. Confirmed cases (n=161) were compared with AHS cohort members without AMD (n=39,108). We estimated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression with adjustment for age, gender, and smoking. RESULTS AMD was associated with ever use of organochlorine [OR=2.7 (95% CI: 1.8, 4.0)] and organophosphate [OR=2.0 (95% CI: 1.3, 3.0)] insecticides and phenoxyacetate herbicides [OR=1.9 (95% CI: 1.2, 2.8)]. Specific pesticides consistently associated with AMD included chlordane, dichlorodiphenyltrichloroethane (DDT), malathion, and captan; others with notable but slightly less consistent associations were heptachlor, diazinon, phorate, 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), and 2,4-dichlorophenoxyacetic acid (2,4-D). Results were similar for men and women. Some specific pesticides were associated with both early- and late-stage AMD, but others were associated with only one stage. CONCLUSIONS Exposures to specific pesticides may be modifiable risk factors for AMD. https://doi.org/10.1289/EHP793.
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Affiliation(s)
- Martha P Montgomery
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
| | - Eric Postel
- Department of Ophthalmology, Duke University Medical School , Durham, North Carolina, USA
| | - David M Umbach
- Biostatistics and Computational Biology Branch, NIEHS, NIH, DHHS , Research Triangle Park, North Carolina, USA
| | | | - Mary Watson
- Social & Scientific Systems, Inc. , Durham, North Carolina, USA
| | - Aaron Blair
- Occupational and Environmental Epidemiology Branch, National Cancer Institute, NIH, DHHS , Rockville, Maryland, USA
| | - Honglei Chen
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
| | - Silke Schmidt
- Department of Medicine, Duke University Medical School , Durham, North Carolina, USA
| | - Freya Kamel
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS) , Research Triangle Park, North Carolina, USA
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Christensen L, Cerda A, Olson JL. Real-time measurement of needle forces and acute pressure changes during intravitreal injections. Clin Exp Ophthalmol 2017; 45:820-827. [PMID: 28418609 DOI: 10.1111/ceo.12963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study was to use a physiological pressure transducer to measure real-time, continuous pressure changes in an ex vivo study model of porcine eyes to record the amount of force needed for scleral penetration and to measure acute intraocular pressure rise during intravitreal injections. METHODS A pressure transducer was inserted into the anterior chamber of 30 fresh porcine eyes, and intraocular pressure was measured 2 s prior to intravitreal injection until 2 s after. A force transducer plate was used to insert various gauge needles into the vitreous cavity and the amount of force in Newtons (N) required for scleral penetration was recorded. RESULTS For scleral perforation, 32- and 30-gauge needles required 0.44 N and 0.45 N, significantly less than larger gauge needles (P < 0.05). Similarly, 27- and 25-gauge needles required more force than smaller gauge needles but less than 19 gauge (P < 0.05). Intraocular pressure increased an average of 64.5 mmHg during intravitreal injection. Two seconds postinjection intraocular pressure readings showed a residual intraocular pressure increase of 11.1 mmHg from pre-injection baseline. CONCLUSION Real-time continuous recordings of pressure reveal that an instantaneous intraocular pressure spike occurs during intravitreal injection and appears to be separate from the intraocular pressure spike that occurs during needle insertion. This pressure spike is transient and has not been captured by previous methods of intraocular pressure measurement, which rely on single time point measurements. The clinical significance of this brief intraocular pressure spike is unclear and warrants further investigation.
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Affiliation(s)
| | - Ashlee Cerda
- University of Colorado Eye Center, Aurora, Colorado, USA
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Nommiste B, Fynes K, Tovell VE, Ramsden C, da Cruz L, Coffey P. Stem cell-derived retinal pigment epithelium transplantation for treatment of retinal disease. PROGRESS IN BRAIN RESEARCH 2017; 231:225-244. [PMID: 28554398 DOI: 10.1016/bs.pbr.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Age-related macular degeneration remains the most common cause of blindness in the western world, severely comprising patients' and carers' quality of life and presenting a great cost to the healthcare system. As the disease progresses, the retinal pigmented epithelium (RPE) layer at the back of the eye degenerates, contributing to a series of events resulting in visual impairment. The easy accessibility of the eye has allowed for in-depth study of disease progression in patients, while in vivo studies have facilitated investigations into healthy and diseased RPE. Consequently, a number of research groups are examining different approaches for the replacement of RPE cells in age-related macular degeneration (AMD) patients. This chapter examines some of these initial proof-of-principle studies and goes on to review the use of pluripotent stem cells as a source for RPE replacement in a number of current AMD clinical trials. Finally, we consider just some of the regulatory and manufacturing challenges presented in taking a promising AMD treatment from the research bench into clinical trials in patients, and how to mitigate potential risks early in process development.
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Affiliation(s)
| | - Kate Fynes
- Institute of Ophthalmology, London, United Kingdom
| | | | - Conor Ramsden
- Institute of Ophthalmology, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Lyndon da Cruz
- Institute of Ophthalmology, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Peter Coffey
- Institute of Ophthalmology, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Center for Stem Cell Biology and Engineering, Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, CA, United States.
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Hudecek M, Izsvák Z, Johnen S, Renner M, Thumann G, Ivics Z. Going non-viral: the Sleeping Beauty transposon system breaks on through to the clinical side. Crit Rev Biochem Mol Biol 2017; 52:355-380. [PMID: 28402189 DOI: 10.1080/10409238.2017.1304354] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Molecular medicine has entered a high-tech age that provides curative treatments of complex genetic diseases through genetically engineered cellular medicinal products. Their clinical implementation requires the ability to stably integrate genetic information through gene transfer vectors in a safe, effective and economically viable manner. The latest generation of Sleeping Beauty (SB) transposon vectors fulfills these requirements, and may overcome limitations associated with viral gene transfer vectors and transient non-viral gene delivery approaches that are prevalent in ongoing pre-clinical and translational research. The SB system enables high-level stable gene transfer and sustained transgene expression in multiple primary human somatic cell types, thereby representing a highly attractive gene transfer strategy for clinical use. Here we review several recent refinements of the system, including the development of optimized transposons and hyperactive SB variants, the vectorization of transposase and transposon as mRNA and DNA minicircles (MCs) to enhance performance and facilitate vector production, as well as a detailed understanding of SB's genomic integration and biosafety features. This review also provides a perspective on the regulatory framework for clinical trials of gene delivery with SB, and illustrates the path to successful clinical implementation by using, as examples, gene therapy for age-related macular degeneration (AMD) and the engineering of chimeric antigen receptor (CAR)-modified T cells in cancer immunotherapy.
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Affiliation(s)
- Michael Hudecek
- a Medizinische Klinik und Poliklinik II , Universitätsklinikum Würzburg , Würzburg , Germany
| | - Zsuzsanna Izsvák
- b Mobile DNA , Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC) , Berlin , Germany
| | - Sandra Johnen
- c Department of Ophthalmology , University Hospital RWTH Aachen , Aachen , Germany
| | - Matthias Renner
- d Division of Medical Biotechnology , Paul Ehrlich Institute , Langen, Germany
| | - Gabriele Thumann
- e Département des Neurosciences Cliniques Service d'Ophthalmologie , Hôpitaux Universitaires de Genève , Genève , Switzerland
| | - Zoltán Ivics
- d Division of Medical Biotechnology , Paul Ehrlich Institute , Langen, Germany
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Roisman L, Goldhardt R. OCT Angiography: An Upcoming Non-invasive Tool for Diagnosis of Age-related Macular Degeneration. CURRENT OPHTHALMOLOGY REPORTS 2017; 5:136-140. [PMID: 29051844 DOI: 10.1007/s40135-017-0131-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the most recent findings, characteristics, faults and future perspectives of optical coherence tomography angiography (OCTA) in age-related macular degeneration (AMD). RECENT FINDINGS In dry AMD, OCTA is useful on the evaluation of choriocapillaris perfusion and detection of naïve quiescent non-exudative choroidal neovascularization (CNV). In wet AMD, OCTA can provide detailed anatomic and morphologic information of CNVs, which may help to understand why and how they develop and become active. In other hand, the many artifacts present in OCTA images may lead to misinterpretation and misdiagnosis. SUMMARY OCTA is a still developing technology that is able to provide a large amount of anatomic, functional and morphologic information in macular diseases and, particularly, AMD. As the technology evolves, the need of dye-based modalities tends to decrease.
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Rao P, Yonekawa Y, Abbey AM, Shah AA, Wolfe JD, Faia LJ. Prevalence and Surgical Outcomes of Macular Hole in Eyes with Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2017; 1:158-164. [DOI: 10.1016/j.oret.2016.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
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Thumann G, Harmening N, Prat-Souteyrand C, Marie C, Pastor M, Sebe A, Miskey C, Hurst LD, Diarra S, Kropp M, Walter P, Scherman D, Ivics Z, Izsvák Z, Johnen S. Engineering of PEDF-Expressing Primary Pigment Epithelial Cells by the SB Transposon System Delivered by pFAR4 Plasmids. MOLECULAR THERAPY-NUCLEIC ACIDS 2017; 6:302-314. [PMID: 28325297 PMCID: PMC5363513 DOI: 10.1016/j.omtn.2017.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 01/14/2023]
Abstract
Neovascular age-related macular degeneration (nvAMD) is characterized by choroidal blood vessels growing into the subretinal space, leading to retinal pigment epithelial (RPE) cell degeneration and vision loss. Vessel growth results from an imbalance of pro-angiogenic (e.g., vascular endothelial growth factor [VEGF]) and anti-angiogenic factors (e.g., pigment epithelium-derived factor [PEDF]). Current treatment using intravitreal injections of anti-VEGF antibodies improves vision in about 30% of patients but may be accompanied by side effects and non-compliance. To avoid the difficulties posed by frequent intravitreal injections, we have proposed the transplantation of pigment epithelial cells modified to overexpress human PEDF. Stable transgene integration and expression is ensured by the hyperactive Sleeping Beauty transposon system delivered by pFAR4 miniplasmids, which have a backbone free of antibiotic resistance markers. We demonstrated efficient expression of the PEDF gene and an optimized PEDF cDNA sequence in as few as 5 × 103 primary cells. At 3 weeks post-transfection, PEDF secretion was significantly elevated and long-term follow-up indicated a more stable secretion by cells transfected with the optimized PEDF transgene. Analysis of transgene insertion sites in human RPE cells showed an almost random genomic distribution. The results represent an important contribution toward a clinical trial aiming at a non-viral gene therapy of nvAMD.
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Affiliation(s)
- Gabriele Thumann
- Department of Ophthalmology, University Hospitals of Geneva, 1205 Geneva, Switzerland; Laboratory of Ophthalmology, University of Geneva, 1205 Geneva, Switzerland.
| | - Nina Harmening
- Laboratory of Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | | | - Corinne Marie
- CNRS, Unité de Technologies Chimiques et Biologiques pour la Santé UMR 8258, 75006 Paris, France; Université Paris Descartes, Sorbonne-Paris-Cité, UTCBS, 75006 Paris, France; INSERM, UTCBS U 1022, 75006 Paris, France; Chimie ParisTech, PSL Research University, UTCBS, 75005 Paris, France
| | - Marie Pastor
- CNRS, Unité de Technologies Chimiques et Biologiques pour la Santé UMR 8258, 75006 Paris, France; Université Paris Descartes, Sorbonne-Paris-Cité, UTCBS, 75006 Paris, France; INSERM, UTCBS U 1022, 75006 Paris, France; Chimie ParisTech, PSL Research University, UTCBS, 75005 Paris, France
| | - Attila Sebe
- Division of Medical Biotechnology, Paul-Ehrlich-Institute, 63225 Langen, Germany
| | - Csaba Miskey
- Division of Medical Biotechnology, Paul-Ehrlich-Institute, 63225 Langen, Germany
| | - Laurence D Hurst
- Department of Biology and Biochemistry, University of Bath, BA2 7AY Bath, UK
| | - Sabine Diarra
- Department of Ophthalmology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Martina Kropp
- Laboratory of Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Peter Walter
- Department of Ophthalmology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Daniel Scherman
- CNRS, Unité de Technologies Chimiques et Biologiques pour la Santé UMR 8258, 75006 Paris, France; Université Paris Descartes, Sorbonne-Paris-Cité, UTCBS, 75006 Paris, France; INSERM, UTCBS U 1022, 75006 Paris, France; Chimie ParisTech, PSL Research University, UTCBS, 75005 Paris, France
| | - Zoltán Ivics
- Division of Medical Biotechnology, Paul-Ehrlich-Institute, 63225 Langen, Germany
| | - Zsuzsanna Izsvák
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, 13092 Berlin, Germany
| | - Sandra Johnen
- Department of Ophthalmology, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Eisenhauer B, Natoli S, Liew G, Flood VM. Lutein and Zeaxanthin-Food Sources, Bioavailability and Dietary Variety in Age-Related Macular Degeneration Protection. Nutrients 2017; 9:nu9020120. [PMID: 28208784 PMCID: PMC5331551 DOI: 10.3390/nu9020120] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 02/04/2017] [Indexed: 01/22/2023] Open
Abstract
Lutein and zeaxanthin (L/Z) are the predominant carotenoids which accumulate in the retina of the eye. The impact of L/Z intake on the risk and progression of age-related macular degeneration (AMD), a leading cause of blindness in the developed world, has been investigated in cohort studies and clinical trials. The aims of this review were to critically examine the literature and evaluate the current evidence relating to L/Z intake and AMD, and describe important food sources and factors that increase the bioavailability of L/Z, to inform dietary models. Cohort studies generally assessed L/Z from dietary sources, while clinical trials focused on providing L/Z as a supplement. Important considerations to take into account in relation to dietary L/Z include: nutrient-rich sources of L/Z, cooking methods, diet variety and the use of healthy fats. Dietary models include examples of how suggested effective levels of L/Z can be achieved through diet alone, with values of 5 mg and 10 mg per day described. These diet models depict a variety of food sources, not only from dark green leafy vegetables, but also include pistachio nuts and other highly bioavailable sources of L/Z such as eggs. This review and the diet models outlined provide information about the importance of diet variety among people at high risk of AMD or with early signs and symptoms of AMD.
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Affiliation(s)
| | - Sharon Natoli
- Food and Nutrition Australia, Sydney NSW 2000, Australia.
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, The University of Sydney, Sydney NSW 2145, Australia.
| | - Victoria M Flood
- Faculty of Health Science, The University of Sydney, Sydney NSW 2141, Australia.
- Westmead Hospital, Western Sydney Local Health District, Westmead, Sydney NSW 2145, Australia.
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Zhu C, Dong Y, Liu H, Ren H, Cui Z. Hesperetin protects against H 2O 2-triggered oxidative damage via upregulation of the Keap1-Nrf2/HO-1 signal pathway in ARPE-19 cells. Biomed Pharmacother 2017; 88:124-133. [PMID: 28103505 DOI: 10.1016/j.biopha.2016.11.089] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022] Open
Abstract
Age-related macular degeneration (AMD) is an irreversible vision loss disease that primarily results from oxidative stress that causes oxidative damage to the retinal pigment epithelial (RPE) cells. Hesperetin (Hesp) is a common flavanone glycoside compound that has been demonstrated to exhibit a variety of biological and pharmacological properties that include anti-inflammatory and antioxidant properties. The aim of this study is to explore the ability of Hesp to attenuate oxidative damage in hydrogen peroxide (H2O2)-stimulated ARPE-19 cells. The results indicated that Hesp treatment not only increased cell survival but also decreased reactive oxygen species (ROS) generation, whereas these roles were effectively enhanced the superoxide dismutase (SOD) and glutathione (GSH) levels, and reduced malondialdehyde (MDA) formation. Importantly, the level of heme oxygenase-1 (HO-1) expression was increased by Hesp exposure, which resulted in a decrease after the transfection of cells with Nrf2-siRNA. Additionally, further results revealed that Hesp treatment significantly elevated Keap-1 protein expression, Nrf2 nuclear translocation and ARE activities. These observations indicated that Hesp treatment effectively protected against H2O2-induced oxidative damage in ARPE-19 cells by inhibiting cell apoptosis, ROS overproduction and MDA formation as well as enhancing the SOD and GSH levels. The underlying mechanisms may be related to the activation of the Keap1-Nrf2/HO-1 signal pathway, which may provide biological evidence to further encourage the investigation of the protective effect of Hesp in AMD disease.
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Affiliation(s)
- Chao Zhu
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun 130041, China
| | - Yuchen Dong
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun 130041, China
| | - Haile Liu
- Department of Ophthalmology, First Hospital of Jilin University, Changchun 130021, China, China
| | - Hua Ren
- Department of Ophthalmology, First Hospital of Jilin University, Changchun 130021, China, China.
| | - Zhihua Cui
- Department of Ophthalmology, First Hospital of Jilin University, Changchun 130021, China, China.
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Neffendorf JE, Desai R, Wang Y, Kelly J, Murphy C, Reeves BC, Chakravarthy U, Wordsworth S, Lewis C, Peacock J, Uddin S, O'Sullivan JM, Jackson TL. StereoTactic radiotherapy for wet Age-Related macular degeneration (STAR): study protocol for a randomised controlled clinical trial. Trials 2016; 17:560. [PMID: 27881184 PMCID: PMC5121938 DOI: 10.1186/s13063-016-1676-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background The standard of care for neovascular age-related macular degeneration (nAMD) involves ongoing intravitreal injections of anti-angiogenic drugs targeting vascular endothelial growth factor (VEGF). The most commonly used anti-VEGF drugs are ranibizumab, bevacizumab and aflibercept. The main objective of the STAR trial is to determine if stereotactic radiotherapy can reduce the number of anti-VEGF injections that patients with nAMD require. Methods/design STAR is a multicentre, double-masked, randomised, sham-controlled clinical trial. It evaluates a new device (manufactured by Oraya, Newark, CA, USA) designed to deliver stereotactic radiotherapy (SRT) to nAMD lesions. The trial enrols participants with chronic, active nAMD. Participants receive a single SRT treatment (16 Gy or sham) with a concomitant baseline intravitreal injection of 0.5 mg ranibizumab. Thereafter, they attend every month for 24 months, and ranibizumab is administered at the visit if retreatment criteria are met. The primary outcome is the number of pro re nata ranibizumab injections during the first 24 months. Secondary outcomes include visual acuity, lesion morphology, quality of life and safety. Additional visits occur at 36 and 48 months to inspect for radiation retinopathy. The target sample size of 411 participants (randomised 2:1 in favour of radiation) is designed to detect a reduction of 2.5 injections against ranibizumab monotherapy, at 90% power, and a significance level (alpha) of 0.025 (one-sided two-sample t test). This gives 97% power to detect non-inferiority of visual acuity at a five-letter margin. The primary analyses will be by intention to treat. Discussion The safety and efficacy outcomes will help determine the role of SRT in the management of chronic, active nAMD. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN12884465. Registered on 28 November 2014. ClinicalTrials.gov: NCT02243878. Registered on 17 September 2014.
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Affiliation(s)
- James E Neffendorf
- Department of Ophthalmology, King's College Hospital, London, UK.,School of Medicine, King's College London, London, UK
| | - Riti Desai
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Yanzhong Wang
- Division of Health and Social Care Research, King's College London, London, UK
| | - Joanna Kelly
- King's Clinical Trials Unit, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, King's College London, London, UK
| | | | - Usha Chakravarthy
- Central Angiographic Resource Facility, Queen's University of Belfast, Belfast, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Cornelius Lewis
- Medical Physics and Engineering, King's College Hospital, London, UK
| | - Janet Peacock
- Division of Health and Social Care Research, King's College London, London, UK
| | - Shahir Uddin
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
| | - Timothy L Jackson
- Department of Ophthalmology, King's College Hospital, London, UK. .,School of Medicine, King's College London, London, UK.
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Dalton AC, Shlamkovitch T, Papo N, Barton WA. Constitutive Association of Tie1 and Tie2 with Endothelial Integrins is Functionally Modulated by Angiopoietin-1 and Fibronectin. PLoS One 2016; 11:e0163732. [PMID: 27695111 PMCID: PMC5047623 DOI: 10.1371/journal.pone.0163732] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/13/2016] [Indexed: 12/29/2022] Open
Abstract
Functional cross-talk between Tie2 and Integrin signaling pathways is essential to coordinate endothelial cell adhesion and migration in response to the extracellular matrix, yet the mechanisms behind this phenomenon are unclear. Here, we examine the possibility that receptor cross-talk is driven through uncharacterized Tie-integrin interactions on the endothelial surface. Using a live cell FRET-based proximity assay, we monitor Tie-integrin receptor recognition and demonstrate that both Tie1 and Tie2 readily associate with integrins α5ß1 and αVß3 through their respective ectodomains. Although not required, Tie2-integrin association is significantly enhanced in the presence of the extracellular component and integrin ligand fibronectin. In vitro binding assays with purified components reveal that Tie-integrin recognition is direct, and further demonstrate that the receptor binding domain of the Tie2 ligand Ang-1, but not the receptor binding domain of Ang-2, can independently associate with α5ß1 or αVß3. Finally, we reveal that cooperative Tie/integrin interactions selectively stimulate ERK/MAPK signaling in the presence of both Ang-1 and fibronectin, suggesting a molecular mechanism to sensitize Tie2 to extracellular matrix. We provide a mechanistic model highlighting the role of receptor localization and association in regulating distinct signaling cascades and in turn, the angiogenic switch.
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Affiliation(s)
- Annamarie C. Dalton
- Virginia Commonwealth University, Department of Biochemistry and Molecular Biology, Richmond, Virginia, 23298, United States of America
| | - Tomer Shlamkovitch
- Ben-Gurion University of the Negev, Department of Biotechnology Engineering and the National Institute of Biotechnology in the Negev, Beer-Sheva, 8410501, Israel
| | - Niv Papo
- Ben-Gurion University of the Negev, Department of Biotechnology Engineering and the National Institute of Biotechnology in the Negev, Beer-Sheva, 8410501, Israel
| | - William A. Barton
- Virginia Commonwealth University, Department of Biochemistry and Molecular Biology, Richmond, Virginia, 23298, United States of America
- * E-mail:
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Boulanger-Scemama E, Sayag D, Ha Chau Tran T, Quaranta-El Maftouhi M, Rumen F, Creuzot-Garcher C, Blanco Garavito R, Jung C, Souied E. [Ranibizumab and exudative age-related macular degeneration: 5-year multicentric functional and anatomical results in real-life practice]. J Fr Ophtalmol 2016; 39:668-674. [PMID: 27609025 DOI: 10.1016/j.jfo.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE The goal of this study was to evaluate five year functional and anatomical outcomes of wet AMD patients treated with ranibizumab according to a pro re nata (PRN) regimen in real-life practice. METHODS A retrospective, multicentric chart review of 201 eyes of 201 patients who underwent their first ranibizumab intravitreal injection (IVT) between January 1, 2007 and December 31, 2008 was performed. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on SD-OCT, number of IVT and follow-up visits were collected at baseline and during the entire follow-up period of 5 years. RESULTS Mean BCVA at baseline was 52.3±16.5 letters. Mean BCVA change from baseline was respectively +2.8, +2.5, +1.8, -0.6 at 1, 2, 3, 4 years of follow-up. At year 5, 43% of eyes had a stable or improved letter score (≥0 letter gain), whereas 29% declined by 15 letters or more, with an overall significant mean decline of 2.8 letters (P<0.05). No correlation was observed between final visual outcome and age, baseline BCVA, type of neovascularization, naive status, number of IVT or number of follow-up visits. On SD-OCT, mean CMT was 293±96μm at baseline and was significantly reduced compared to baseline at each year end-point (P<0.005). The mean number of IVT was 15±10.4 at year 5, with 55% of eyes still being under active treatment. CONCLUSION PRN ranibizumab in real-life practice improved or stabilized visual acuity over 4 years. During the 5th year, progressive decline of visual acuity was observed.
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Affiliation(s)
- E Boulanger-Scemama
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - D Sayag
- Centre Explore Vision, 75001 Paris, France
| | - T Ha Chau Tran
- Service d'ophtalmologie, groupement des hôpitaux catholique de Lille, université catholique de Lille, 59000 Lille, France
| | | | - F Rumen
- Centre Atlantique de la Vision, 17140 La Rochelle, France
| | | | - R Blanco Garavito
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - C Jung
- Centre de recherche clinique, université Paris Est Créteil, CHI de Créteil, 94000 Créteil, France
| | - E Souied
- Service d'ophtalmologie, université Paris Est Créteil, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Shuai P, Ye Z, Liu Y, Qu C, Liu X, Luo H, Feng X, Li X, Shi Y, Gong B. Association between SKIV2L polymorphism rs429608 and age-related macular degeneration: A meta-analysis. Ophthalmic Genet 2016; 38:245-251. [PMID: 27484132 DOI: 10.1080/13816810.2016.1210650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ping Shuai
- College of Life Science and Engineering, Southwest Jiaotong University, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Health Management Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Zimeng Ye
- College of Life Science and Engineering, Southwest Jiaotong University, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuping Liu
- Health Management Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chao Qu
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoqi Liu
- College of Life Science and Engineering, Southwest Jiaotong University, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Huaichao Luo
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyun Feng
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiulan Li
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Shi
- College of Life Science and Engineering, Southwest Jiaotong University, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Gong
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Whiting P, Kerby J, Coffey P, da Cruz L, McKernan R. Progressing a human embryonic stem-cell-based regenerative medicine therapy towards the clinic. Philos Trans R Soc Lond B Biol Sci 2016; 370:20140375. [PMID: 26416684 DOI: 10.1098/rstb.2014.0375] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since the first publication of the derivation of human embryonic stem cells in 1998, there has been hope and expectation that this technology will lead to a wave of regenerative medicine therapies with the potential to revolutionize our approach to managing certain diseases. Despite significant resources in this direction, the path to the clinic for an embryonic stem-cell-based regenerative medicine therapy has not proven straightforward, though in the past few years progress has been made. Here, with a focus upon retinal disease, we discuss the current status of the development of such therapies. We also highlight some of our own experiences of progressing a retinal pigment epithelium cell replacement therapy towards the clinic.
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Affiliation(s)
- Paul Whiting
- Pfizer Neusentis, Granta Park, Cambridge CB21 6GS, UK
| | - Julie Kerby
- Pfizer Neusentis, Granta Park, Cambridge CB21 6GS, UK
| | - Peter Coffey
- The London Project to Cure Blindness, Division of ORBIT, Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Lyndon da Cruz
- The London Project to Cure Blindness, Division of ORBIT, Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Ruth McKernan
- Pfizer Neusentis, Granta Park, Cambridge CB21 6GS, UK
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A Large Outbreak of Fulminant Bacterial Endophthalmitis after Intravitreal Injection of Counterfeit Bevacizumab. Graefes Arch Clin Exp Ophthalmol 2016; 254:1851-6. [PMID: 27377655 DOI: 10.1007/s00417-016-3426-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/21/2016] [Accepted: 06/22/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE This study reports the findings in a large series of patients with acute bacterial endophthalmitis after intravitreal injection of bevacizumab (IVB) in two eye hospitals. METHODS Medical records were reviewed for patients who presented with acute fulminant endophthalmitis in one or two eyes following intravitreal injection of bevacizumab from two separate batches in two eye hospitals. RESULTS Twenty-eight eyes of 21 patients presented with acute endophthalmitis 12-48 hours after IVB injection. Cultures from the eyes and the vials were positive for E. coli and Citrobacter, each in one of the hospitals. All patients were initially treated with topical, intravitreal, and systemic antibiotics. Twenty-four eyes underwent pars plana vitrectomy. Best corrected visual acuity (BCVA) was 1.27 ± 0.89 logMAR before IVB injecti,on which decreased to 2.80 ± 0.45 LogMAR after presentation of endophthalmitis and 2.12 ± 0.97 logMAR three months after IVB injection. Final visual acuity was found to be no light perception in four eyes. CONCLUSIONS This large outbreak of E.coli and Citrobacter endophthalmitis occurred after intravitreal injection of counterfeit bevacizumab. Visual outcomes were very poor.
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Nudleman E, Wolfe JD, Woodward MA, Yonekawa Y, Williams GA, Hassan TS. Worsening anatomic outcomes following aflibercept for neovascular age-related macular degeneration in eyes previously well controlled with ranibizumab. Clin Ophthalmol 2016; 10:1053-7. [PMID: 27354759 PMCID: PMC4907716 DOI: 10.2147/opth.s109894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Antivascular endothelial growth factor injection is the mainstay of treating neovascular age-related macular degeneration (AMD). Previous studies have shown that switching treatment from ranibizumab to aflibercept led to an improvement in eyes with recalcitrant activity. Herein, we identify a unique subset of patients whose eyes with neovascular AMD were previously well controlled with ranibizumab injections were then worsened after being switched to aflibercept. Methods This is a retrospective interventional case series. Eyes with neovascular AMD, previously well controlled with monthly injections of ranibizumab, which then developed worsening of subretinal fluid after being switched to aflibercept were included. Results A total of 17 eyes were included. All eyes developed increased subretinal fluid when switched from ranibizumab to aflibercept. Fourteen patients were switched back to ranibizumab after a single injection of aflibercept and had subsequent rapid resolution of subretinal fluid. Three patients continued with monthly aflibercept injections for two subsequent months and demonstrated the persistence of the increased subretinal fluid until they were switched back to treatment with ranibizumab at which time the fluid resolved. No eye had persistent decline in visual acuity. Conclusion Switching from intravitreal ranibizumab to aflibercept in eyes with well-controlled neovascular AMD may result in worsening in a subset of patients and resolves when therapy is switched back to ranibizumab.
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Affiliation(s)
- Eric Nudleman
- Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla, CA, USA
| | - Jeremy D Wolfe
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Ann Arbor, MI, USA; Associated Retinal Consultants, Royal Oak, Ann Arbor, MI, USA
| | - Maria A Woodward
- Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yoshihiro Yonekawa
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Ann Arbor, MI, USA; Associated Retinal Consultants, Royal Oak, Ann Arbor, MI, USA
| | - George A Williams
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Ann Arbor, MI, USA; Associated Retinal Consultants, Royal Oak, Ann Arbor, MI, USA
| | - Tarek S Hassan
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Ann Arbor, MI, USA; Associated Retinal Consultants, Royal Oak, Ann Arbor, MI, USA
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Pérez-Canales JL, Rico-Sergado L, Pérez-Santonja JJ. Self-Reported Sleep Duration in Patients with Neovascular Age-Related Macular Degeneration. Ophthalmic Epidemiol 2016; 23:20-6. [PMID: 26786476 DOI: 10.3109/09286586.2015.1119288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the relationship between self-reported sleep duration and neovascular age-related macular degeneration (nAMD). METHODS This case-control study comprised 165 subjects (57 patients with nAMD and 108 controls). Controls were matched to cases by age and sex. Participants completed a questionnaire that included questions about sleep duration and quality. Four categories of sleep duration were established; <6 hours, 6-7 hours, 7-8 hours and >8 hours. Association of sleep duration and nAMD was assessed by logistic regression analysis. Multiple logistic regression models were performed to control for possible confounders. RESULTS We found a significant association between short sleep duration and nAMD (for <6 hours, odds ratio, OR, 3.29, 95% confidence interval, CI, 1.32-8.27; for 6-7 hours, OR 2.25, 95% CI 0.80-6.32; and for >8 hours, OR 1.39, 95% CI 0.53-3.73) compared with the reference category of 7-8 hours. This association remained significant after adjustment for confounders (<6 hours, OR 3.09, 95% CI 1.20-7.97). In addition, a borderline significant association was observed between self-reported very bad sleep quality and nAMD (OR 2.84, 95% CI 1.02-7.88). The highest rate of sleep medication use was found in the nAMD group (p < 0.001). CONCLUSION Our findings provide evidence to support an association between short sleep duration and nAMD. Considering strategies to improve sleep in these patients may prevent the negative effects of sleep deficiency.
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Affiliation(s)
- Jose L Pérez-Canales
- a Department of Ophthalmology , Alicante University General Hospital , Alicante , Spain
| | - Laura Rico-Sergado
- a Department of Ophthalmology , Alicante University General Hospital , Alicante , Spain
| | - Juan J Pérez-Santonja
- a Department of Ophthalmology , Alicante University General Hospital , Alicante , Spain.,b OftalVist Group , Alicante , Spain
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Boulanger-Scemama E, Querques G, About F, Puche N, Srour M, Mane V, Massamba N, Canoui-Poitrine F, Souied E. Ranibizumab for exudative age-related macular degeneration: A five year study of adherence to follow-up in a real-life setting. J Fr Ophtalmol 2015; 38:620-7. [DOI: 10.1016/j.jfo.2014.11.015] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022]
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Matamoros E, Maurel F, Léon N, Solomiac A, Bardoulat I, Joubert M, Hermans M, Moser E, Le Picard S, Souied EH, Leveziel N. Quality of Life in Patients Suffering from Active Exudative Age-Related Macular Degeneration: The EQUADE Study. Ophthalmologica 2015; 234:151-9. [PMID: 26337381 DOI: 10.1159/000433448] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/18/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Age-related macular degeneration (AMD) is the main cause of visual loss in the elderly population. With the use of anti-vascular endothelial growth factor, the visual outcomes of exudative AMD patients have been improved. This study was aimed at assessing the quality of life (QoL) of exudative AMD patients treated with ranibizumab and at determining its drivers in a real-life setting. METHODS We performed a national, cross-sectional, observational survey based on questionnaires sent to members of French associations relative to AMD between December 2012 and March 2013. Patients suffering from exudative AMD with at least one intravitreal injection of ranibizumab within the last 6 months were included. Demographics, AMD characteristics, visual acuity (VA) and past and ongoing treatments were collected. The 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was self-administered. A multivariate model was used to identify QoL drivers. RESULTS 416 questionnaires fulfilled the complete criteria for both QoL and cost analyses. The mean age of exudative AMD patients was 78.0 years and bilateral involvement was reported in 60.4%. The overall mean QoL score was 53.4. Mental health, driving and role difficulties were the most widely affected domains. After bivariate analyses, long-term illness status, worse VA and higher number of unpaid aids were associated with worse QoL, with odds ratios of 2.4, 5.2 and 11.6, respectively. The mean cost per year and per patient was 1,741 EUR. The main components of costs were aids and services and the purchase of visual equipment. CONCLUSIONS The main predictors of QoL in exudative AMD patients treated with ranibizumab are VA outcomes, home healthcare and social services provided to the patients.
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Affiliation(s)
- Emilie Matamoros
- Department of Ophthalmology, University Hospital of Poitiers, Poitiers, France
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Kijlstra A, Berendschot TTJM. Age-related macular degeneration: a complementopathy? Ophthalmic Res 2015; 54:64-73. [PMID: 26159686 DOI: 10.1159/000432401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022]
Abstract
Age-related macular degeneration (AMD) is a progressive eye disease affecting many elderly individuals. It has a multifactorial pathogenesis and is associated with numerous environmental (e.g. smoking, light and nutrition) and genetic risk factors. A breakthrough in the mechanisms causing AMD is emerging; the involvement of the alternative pathway of the complement system appears to play a pivotal role. This has led to the statement that AMD is a disease caused by a hyperactive complement system, allowing the term 'complementopathy' to define it more precisely. Abundant evidence includes: the identification of drusen components as activators of complement, immunohistochemical data showing the presence of many species of the complement system in the retinal pigment epithelium-Bruch's membrane-choroidocapillary region of AMD eyes, a strong association of AMD with certain genetic complement protein variants, raised complement levels in blood from AMD patients and the preliminary successful treatments of geographic atrophy with complement factor D (FD) inhibitors. FD is the rate-limiting enzyme of the alternative complement pathway, and is produced by adipose tissue. Recent findings suggest that nutrition may play a role in controlling the level of FD in the circulation. Addressing modifiable risk factors such as smoking and nutrition may thus offer opportunities for the prevention of AMD.
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Affiliation(s)
- Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
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Astle AT, Blighe AJ, Webb BS, McGraw PV. The effect of normal aging and age-related macular degeneration on perceptual learning. J Vis 2015; 15:16. [PMID: 26605694 PMCID: PMC4669204 DOI: 10.1167/15.10.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 10/21/2015] [Indexed: 11/24/2022] Open
Abstract
We investigated whether perceptual learning could be used to improve peripheral word identification speed. The relationship between the magnitude of learning and age was established in normal participants to determine whether perceptual learning effects are age invariant. We then investigated whether training could lead to improvements in patients with age-related macular degeneration (AMD). Twenty-eight participants with normal vision and five participants with AMD trained on a word identification task. They were required to identify three-letter words, presented 10° from fixation. To standardize crowding across each of the letters that made up the word, words were flanked laterally by randomly chosen letters. Word identification performance was measured psychophysically using a staircase procedure. Significant improvements in peripheral word identification speed were demonstrated following training (71% ± 18%). Initial task performance was correlated with age, with older participants having poorer performance. However, older adults learned more rapidly such that, following training, they reached the same level of performance as their younger counterparts. As a function of number of trials completed, patients with AMD learned at an equivalent rate as age-matched participants with normal vision. Improvements in word identification speed were maintained at least 6 months after training. We have demonstrated that temporal aspects of word recognition can be improved in peripheral vision with training across a range of ages and these learned improvements are relatively enduring. However, training targeted at other bottlenecks to peripheral reading ability, such as visual crowding, may need to be incorporated to optimize this approach.
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Orozco-Hernández A, Ortega-Larrocea X, Sánchez-Bermúdez G, García-Aguirre G, Cantón VM, Velez-Montoya R. Acute sterile endophthalmitis following intravitreal bevacizumab: case series. Clin Ophthalmol 2014; 8:1793-9. [PMID: 25228797 PMCID: PMC4164286 DOI: 10.2147/opth.s66230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. Conclusion The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast recognition and accurate differential diagnosis is important to avoid unnecessary treatments and long-term complications. The low incidence of this event should not preclude the use of intravitreal injections in eyes that could benefit greatly from this therapy.
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Affiliation(s)
- Axel Orozco-Hernández
- Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexico City, Mexico
| | | | | | | | | | - Raul Velez-Montoya
- Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA
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